Abstract
Introduction
The 2019 novel coronavirus infection (COVID-19) is a global health crisis which has infected 120 million people worldwide including 29 million people in the United States by early 2021 (Johns Hopkins Coronavirus Resource Center, 2021). The COVID-19 outbreak started in December 2019 and World Health Organization declared it as a pandemic in March 2020 (World Health Organization, 2020). In efforts to minimize the infection and further spreading of the diseases numerous countries around the world had to set forth global and local travel bans, stay-at-home orders, country/city-wide lockdowns, mandated quarantines, self-isolation, and social distancing rules and regulations. In the United States, the first stay-at-home order was imposed by the health authorities in the San Francisco Bay Area effective March 17, 2020, which was then implemented by several states and a large number of local jurisdictions (Moreland et al., 2020). Due to the urban county-wide lockdowns and regulations regarding social distancing, along with university’s research restriction, conducting patient-centered research was significantly affected. Specifically, on-going and planned qualitative research that require face-to-face interactions such as focus groups or in-person interviews had to be transformed in order to be continued in the new environment (Dos Santos Marques et al., 2020; Marhefka et al., 2020; Santhosh et al., 2021).
Focus groups are a commonly used qualitative research technique that involves group interviews that facilitate communication/interactions between the research participants to generate data (Kitzinger, 1995). The focus group discussions are generally focused on a specific topic and explore participants’ opinions, experiences, and perspectives related to the topic. Instead of answering questions by the researcher, the participants in focus groups are encouraged to talk to one another, ask questions, share their experiences and comment on others experiences and point of view (Kitzinger, 1995; Mitchell & Branigan, 2000). This technique has been widely used to evaluate health promotion interventions by collecting data regarding participants experiences related to intervention participation (Adhien et al., 2013; Benavides-Vaello et al., 2004; Maund et al., 2019; Mitchell & Branigan, 2000). Focus groups are traditionally conducted as in-person discussions with a moderator present (Nyumba et al., 2018).
Less common is conducting online focus groups using video conferencing platforms (Abrams et al., 2015; Kite & Phongsavan, 2017; Matthews et al., 2018; Tates et al., 2009; Tuttas, 2015; Wettergren et al., 2016). Although the use of online focus groups is not a novel concept, the use of video conferencing platforms gained traction during the pandemic (Dodds & Hess, 2020; Dos Santos Marques et al., 2020; Marhefka et al., 2020; Santhosh et al., 2021). Developments in technologies such as webcam supported internet-based meeting platforms has provided qualitative researchers an alternative means to conduct focus groups/individual interviews and is proven to be effective in reaching populations whose research participation is limited due to time restrictions, distance, and social barriers (Matthews & Cramer, 2008; Matthews et al., 2018; Rupert et al., 2017; Tates et al., 2009). Studies have shown that the quality or richness of data generated through online focus groups are similar to in-person focus groups (Abrams et al., 2015; Kite & Phongsavan, 2017; Matthews et al., 2018) while slightly reducing the logistical burden on the participants (Rupert et al., 2017).
The literature also provides evidence of successful completion of online focus groups during the COVID-19 pandemic (Dodds & Hess, 2020; Dos Santos Marques et al., 2020). The Dodds and Hess (2020) study was examining the experiences of nine family groups composed of parents and youth involved in a research project exploring the youth alcohol consumption and family communication, that was moved online during lockdown. They reported that the benefits of using online focus groups for participants and researchers included: (1) being comfortable, and the methodology felt non-intrusive and gave a sense of being safe, (2) engaging and convenient, (3) online communication ease, and (4) technically easy for participants to set-up and for researchers to record. However, there were limitations due to participants and researchers having: (1) difficulties reading non-verbal communication, (2) the flow of the conversation would be lost if the internet connection was poor or if the tablet had to be passed around to participants, and (3) participants worried about online privacy and researchers concerned about access issues for those without internet. Dos Santos Marques et al. (2020) conducted their study among a minority surgical population. In addition to successfully conducting online focus groups, they were able to include participants living at a distance >30 miles from the research institution who would have been excluded from in-person focus groups due to travel challenges.
However, none of these studies have used a framework to assess the feasibility (Orsmond & Cohn, 2015) of conducting online focus groups during a pandemic such as COVID-19. Specifically, the feasibility of recruiting participants during a pandemic and transitioning a qualitative study from in-person data collection to online data collection using a video conferencing platform among a low resourced population is unknown. Our research team was conducting a focus group study among low-income community college students who had participated in an 8 month on-campus Food Distribution Program (FDP) to explore students’ experiences with the intervention, when the county-wide lockdown occurred due to COVID-19. To comply with the new implemented restrictions and to ensure participants’ and focus group facilitators’ safety, it was decided to do a mid-study change to the mode of focus groups which involved transforming the in-person discussion to online focus groups using a video conferencing platform.
The purpose of the current study was to use the feasibility framework outlined by Orsmond and Cohn (2015) and to assess (1) the feasibility of recruiting low-income, racial/ethnic minorities to participate in focus groups during a pandemic and their associated sampling characteristics, (2) the feasibility of collecting focus group data through a video conferencing platform, and (3) the feasibility of accessing resources needed to recruit participants during a pandemic and collect data using a video conferencing platform. According to Pew Research Center, the majority of community college students own a cellphone (94%), desktop computer (67%), or a laptop computer (70%), and 94% are internet users (Smith et al., 2011). Thus, we expected conducting online focus groups among this population to be feasible.
Methods
An overview of the recruitment and data collection procedures are presented in Figure 1. This figure depicts the steps needed to transition from in-person focus groups to online focus groups and in the process highlights the similarities and differences in the two approaches. Brief overview of recruitment and data collection procedures for in-person focus groups and transitioning to online focus groups.
Recruitment
The participants in the focus group study were selected based on their participation in a larger intervention study that was conducted from January 2018–May 2019 (Hernandez et al., 2021). The purpose of the focus group was to understand participants’ experiences with the intervention. The focus groups were originally designed to be conducted in-person. Participants were selected into the focus group based on their intervention attendance and completion of at least one survey associated with the intervention. Intervention attendance records were analyzed, and the participants were placed in one of two groups: high attendees or low attendees. High attendees participated in the intervention at least 3 times (out of the possible 16 times). Low attendees participated in the intervention 2 times or less.
On a weekly basis, research assistants were provided with eligible individuals’ contact information based on their attendance category. The goal was to form focus groups based on the two attendance categories. Research assistants were asked to recruit individuals from the high attending category and to form those focus groups first. Research assistants contacted eligible individuals via phone calls to invite them to attend the upcoming focus groups. Voicemails were left for individuals that did not answer the phone call, and if the voicemail was full, the research assistant sent a text message. The day before the focus groups, confirmed individuals were reminded with a text message by a research assistant. On the day of the focus group, confirmed individuals were reminded with a text message by the principal investigator (PI).
Confirmed individuals who did not show up for their focus group meeting were rolled into the recruitment list for the following week and contacted again to re-invite them to the subsequent scheduled focus group. This was done until an eligible individual requested to no longer be contacted or they had been confirmed and no-showed 3 times. Recruitment into the focus groups occurred from January 2020–April 2020.
Data Collection
The focus groups scheduled pre-lockdown were conducted in-person at the PI’s lab on the university campus. Confirmed participants were texted the date and time of the focus group meeting, the name and address to the on-campus building where the focus group was occurring, parking instructions, and the phone number of a research assistant that would be available to assist them on the day of the focus group.
The focus groups scheduled during the lock-down were conducted using the chosen video conferencing platform Zoom. Confirmed participants were texted and emailed the online meeting details, including date and time of the meeting and video conferencing platform log-in instructions. Several procedures were put in place to ensure data collection privacy and maintain confidentiality. For instance, a different meeting code and password was created for each meeting. Each meeting was also “locked” at the beginning. This prevented the meeting from being interrupted by uninvited guest (i.e., Zoom bombing or Zoom raiding). A research assistant was also available on the day of the online focus groups to troubleshoot difficulties with the video conferencing platform, such as downloading the application and logging into the meeting.
Each focus group discussion was opened with an introduction of the study providing participants information related to the purpose of the discussion and its confidentiality. Next, for in-person focus groups the PI reviewed and provided the written documentation of informed consent to the participants; for online focus groups a waiver of documentation of informed consent was reviewed with the participants and verbal consent was audio-recorded. A semi-structured focus group interview guide was developed by the research team and used to facilitate the discussions. The discussions inquired into the following domains: (a) barriers to participating in the FDP/barriers to accessing food in general, (b) facilitators to participating in the FDP/facilitators to accessing food in general, (c) suggestions to improve the FDP, and (d) description of pictures they would use to describe the benefits and challenges that were discussed. All participants were given sufficient opportunities to share their experiences and views of the FDP. Each focus group was audio-recorded and transcribed near verbatim. That is, inaudible and distinct sounds that did not disrupt or impact the point that was being made by the participant were not transcribed (e.g., false starts, stutters, environmental sounds, and laughter). Further, memos were written by the focus group facilitators, including researchers' reflections and observations.
Upon completion of the focus group, participants received a US $25 gift card to a national discounted department and grocery store for their attendance. A light lunch and a parking voucher were also offered to the participants who participated in the in-person focus groups. The in-person focus groups conducted pre-lockdown were conducted from late January 2020 to mid-March 2020 (i.e., 7 weeks). The online focus groups were conducted between the end of March 2020 through April 2020 (i.e., 5 weeks). Data collection was approved by the University of Houston’s Institutional Review Board, and data analyses was approved by the University of Texas Health Science Center’s Institutional Review Board.
Measures
Sample Characteristics
Socio-demographic characteristics of the individuals that confirmed their interest in participating in the focus group were extracted from the administrative data: age, gender (male, female), race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, other), marital status (married, divorced, separated, single), academic level (freshman, sophomore, associate degree, bachelor’s degree, master’s degree, unclassified), and employment status (full-time, part-time, not employed). Three indicators of household material hardship were extracted from survey data corresponding to the larger intervention study (i.e., unable to pay or underpay your rent or mortgage; unable to pay the full amount of a gas, oil, or electricity bill; borrow money to pay bills) (Hernandez et al., 2021). Participants responded to each item as to whether they had experienced the specified material hardship during the past 12 months.
Recruitment Capability
Recruitment capability was quantified through various counts documented by the research team pre- and during the lockdown. The total number of focus groups conducted and total number of participants who attended were recorded. In addition, recruitment efforts were logged in terms of the number of eligible participants recruited per focus group and the number of times participants were initially contacted by phone call, voice mail, and text messages per focus group prior to providing a confirmation. The number of eligible participants that confirmed their focus group attendance per focus group and the number of eligible participants that attended the focus group each time there was a meeting was also recorded. The modes of confirming interest in participating in the focus group was also recorded.
Data Collection Procedures
The research team recorded numerous indicators that can be used to evaluate data collections procedures. The frequency by which focus groups occurred, the day and time of day which focus groups occurred, whether focus groups started on time or whether there was a delay, and whether participants perceived data collection to be burdensome were logged. In addition, the length of each focus group was also documented based on the audio recordings. Last, participant reactions to data collection (e.g., praises/complaints) were also recorded.
Resources
To gauge the resources needed to transition a study from in-person to online, the research team documented the administrative capacity needed to manage the project, recruit participants, and collect data. The space, technology, and funds necessary to cover the cost of the study were also logged.
Statistical Analysis
Among the confirmed individuals interested in participating in the focus group, the socio-demographic and material hardship characteristics were compared between individuals who confirmed but did not attend (i.e., non-attendees) and individuals who confirmed and attended (i.e., attendees) using independent t-test for continuous variable and proportion test for categorical variables. The differences among attendee characteristics, the differences between various recruitment capability counts, and the length of focus groups were evaluated by pre- and during lockdown status using independent t-test for continuous variable and proportion test for categorical variables.
Results
Evaluation of Resulting Sample Characteristics
There was a total of 407 individuals from the larger intervention study (117 = high attendees and 290 = low/no attendees) eligible to participate in the focus groups (Figure 2). A total of 87 eligible participants confirmed interest in participating in the focus groups; however, only 36 (21 = high attendees and 15 = low/no attendees) attended the focus groups. There were no significant differences between the focus groups attendees and non-attendees except for the age (Table 1). The focus group attendees were significantly older compared to non-attendees (age = 32 vs. 40, Sample selection and participation in the focus groups. Characteristics of Confirmed Individuals Interested in Participating in Focus Group and Focus Group Attendees, Reported as Mean (Standard Deviation) or Number (%). *
Among the 36 individuals that attended the focus groups, 14 participants attended in-person before the lockdown, and 22 participants attended online during the lockdown. The average age of focus group participants was 40 years old between both time points and displayed several socio-economic disadvantaged characteristics. A greater proportion of participants, regardless of the method involved, were female, Black, single, and unemployed. Participants had the most difficulty paying utilities and were likely to borrow money to pay bills from friends or family. Overall, participants before and during the lockdown did not differ on their socio-demographic and material hardship characteristics. A greater proportion of high attendees participated before the county lockdown; however, that was by a consequence of research study design mentioned above.
Evaluation of Recruitment Capability
Evaluation of Recruitment Capability Pre and During the Lockdown.
bExcludes the two pre-lockdown focus groups without any participants.
Among the eligible participants initially contacted by phone, the most frequent mode of confirming participation in the focus group was to confirm or decline while on the phone with the research assistant. The individuals that the research assistants were not able to speak to directly were left voice messages/left messages with someone else and sent text messages inviting them to consider participating in the focus group on a specified day and time. Interested individuals either called back or texted back to express interest in participation (data not shown). Research assistants confirmed participants’ interests by phone and text message. For those who were confirmed for online focus groups during the lockdown, confirmation messages were also sent to their email addresses including the video conferencing link and details. Of the eligible participants who returned calls or text messages, most of them did so to get more information or confirm their interest in attending. However, no participant returned the call or text to decline participation. The recruitment confirmation procedure described above was consistent pre-lockdown and during lockdown.
Evaluation of Data Collection Procedures
Data collection during the pre-lockdown occurred once a week on Saturdays from 10a.m.,–noon, in-person on a college campus. Although the goal was to start at 10a.m., most focus groups started 30 minutes late due to participants arriving late (i.e., leaving their homes late; not being able to find parking or the building on campus). Attendance was logged using attendance sheets. Focus groups were audio recorded using a digital recorder that was operated by the research team.
During the lockdown, data collection occurred up to twice a week on a weekday and times varied, with the most common time being 10a.m. An online video conferencing platform was used to conduct focus groups during the lockdown. All focus groups started within 10 minutes of the initial start time. Attendance was recorded as participants logged in. Focus groups were audio recorded through the video conferencing platform.
Average Minutes of Discussion that Occurred in the Focus Groups Pre- and During the Lockdown Comparisons, Mean (Standard Deviation).
bOne focus group interview was excluded due to non-compliance.
Assessment of Relevant Resources
Several resources made it possible for this study to occur. There were two focus group facilitators and three research assistants. Two research assistants were dedicated to recruitment of participants for the entire duration of the project. Recruitment involved calling, leaving voice messages when calls were not answered, and texting participants. When a participant confirmed, the research assistants sent the potential participant a text message. For the online focus groups, confirmation was also sent by an email with video conferencing details (see research design above). Research assistants were also responsible for sending reminders about the focus group to participants the day before data collection.
On the day of the in-person focus group, one of the research assistants was available 60 minutes prior to data collection starting to setup data collection materials. The research assistant would also stand outside the building waiting for participants to guide them to the lab and assist with parking. Once the focus group began, the research assistant assisted with childcare if there were any children that accompanied a participant. For online focus groups, a research assistant was on standby to answer calls, texts, or emails from participants who had trouble downloading the video conferencing application or had difficulties logging onto the online video conferencing platform.
The PI had access to a large research laboratory that included a conference room, a small kitchenette, and a meeting space. The space made it feasible to conduct focus groups and provide light lunches. The space was also large enough to keep children entertained and away from parents, allowing parents the ability to concentrate on the focus group discussion. Validated parking was available across the street from where the focus groups were occurring. Although some participants initially had difficulty finding the building and associated parking, the parking voucher and short distance between the building and the parking structure appeased the participants.
Aside from gift card compensation, participants who engaged in the in-person focus group were provided a parking voucher and a light lunch that included a sandwich, chips, a cookie, and drink. In order to conduct the online focus groups, it was necessary for the PI to purchase a premium plan for the video conferencing platform to allow multiple attendees without a time cap on any of the meetings. For the online participants, the video conferencing platform was free to download and use. Grant funds associated with the last author of this publication covered all study related costs, which included gift card compensation for both in-person and online focus groups (US$25 per participant). Additional costs for in-person focus groups included parking vouchers (US$12 per participant), food and drink, and food related items that included plates and napkins (US$30–$40 per focus group). For the online focus group meetings, a one-time subscription fee for the video conferencing platform was purchased (US$45, which includes a university discount). (See “
Discussion
Lessons Learned from Conducting Online Focus Groups Based on the Orsmond and Cohn (2015) Feasibility Framework.
Feasibility of Resulting Sample Characteristics
Among the individuals interested in participating in the focus group, attendees were older compared to non-attendees, which suggests that greater efforts are needed to recruit and retain younger, lower-income adults in research studies. However, among the focus group attendees, socio-demographic and material hardship characteristics did not differ between the two groups. Although a county-wide lockdown may have resulted in individuals from different demographic and economic backgrounds from participating in the focus group, this was not the case in our study.
Feasibility of Recruiting Low-income, Racial/ethnic Minorities to Participate in Focus Groups during a Pandemic
Overall, it was feasible to recruit low-income, racial/ethnic minorities to participate in focus groups during a pandemic. The change in work conditions due to county-wide lockdown, along with the university research restrictions, did not affect the average number of participants recruited, confirmed, and attended. Thus, recruitment capability was maintained during the lockdown despite the change in mode by which the focus group was delivered. The communication that occurred among the research team may have facilitated maintaining the recruitment capability during the lockdown. During research team meetings research assistants provided feedback to the PI about the discussions that they had with the interested individuals regarding their preferred day and times for focus groups to occur. Due to restricted schedules held by the focus group facilitators (e.g., in-person teaching and meetings) and participants (e.g., work and school), in-person focus groups were held on-campus on Saturday late mornings. During the lockdown, there was greater flexibility in the facilitators’ and participants’ schedules and focus groups were planned throughout the week and at various times to offer a range of options based on participants schedule and preference. Although 10a.m., on Saturdays continued to be a popular time for the meetings, there was a desire to have the meetings during the weekday and those were implemented.
The most successful form of recruitment was phone calls and text messaging. This is similar to research indicating that among 30–49 year old adults the most used method of communication is texting, followed by email and using a cellphone to make a phone call (Newport, 2014). Among confirmed participants interested in the focus group, multiple text messages as reminders of upcoming data collection, and the use of email to communicate instructions for accessing and using video conferencing platform became a valuable method of communication. To maximize participation, the research team recommends using various modes of communication to varying degrees when recruiting and reminding potential participants of upcoming data collection.
Although there were no differences between pre- and during lockdown in regards to the average number of eligible participants recruited per focus group nor in the average number of eligible participants that confirmed, only about half of the participants that confirmed attended the scheduled focus group (regardless of when the focus group occurred). Economic disadvantage has been associated with chaotic lifestyles and environments (Brown et al., 2019; El-Sheikh et al., 2015), which could explain why some confirmed participants did not attend. In addition to the multiple methods of communication, it is recommended to aim to achieve confirmation from double the desired target sample for each focus group when working with economically disadvantaged populations.
Feasibility of Collecting Focus Group Data through a Video Conferencing Platform
In terms of data collection, using a video conferencing platform to collect focus group data during a pandemic is feasible. Related, when collecting data, it is important to make the process the least burdensome for participants. Prior to the county-wide shut down, several barriers were evident for the research team and for the potential participants. The research team was dependent on the availability of the campus parking during the weekend. Weekend campus events limited parking options for research participants. Regarding the research participants, several interested individuals confirmed but did not show up for the in-person focus groups. Reasons for not attending included childcare needs, conflicting work and class schedules, and personal tragedies, with personal and public transportation challenges being the most dominant. For both the participant and the research team, it was necessary to budget time to travel to- and from- campus during the in-person focus groups. Transitioning data collection to online eliminated the parking and transportation challenges, along with the built-in travel time. Related, the transition also eliminated concerns that participants may have about following driving directions and visiting an unknown environment (i.e., university setting). While the transition did not eliminate the challenges with childcare and work and class schedules, the increase flexibility in the facilitators’ personal schedule to conduct focus groups during the county lockdown did help reduce those challenges for individuals interested in participating in the focus group. The advantages that online focus groups provide, such as the flexibility, the elimination of transportation barriers, and the reduction in time constraints, has been cited by others (Dodds & Hess, 2020; Dos Santos Marques et al., 2020).
Although collecting the data through an online-platform was feasible and reduced burden for the research team and the participants, the non-attendees may have faced additional obstacles that prevented them from attending in-person or online focus group that was not communicated with the research team. Thus, the research team is left to speculate as to why individuals interested in participating in the focus group did not attend. For example, all the eligible individuals that were contacted had access to at least one of the necessary equipment needed—smartphone or a tablet or desktop computer/laptop with camera. However, only one individual that was contacted stated being worried about the length of time they would be required to be on the online video conferencing platform for the focus group and how that would translate in data charges. Because this only occurred once, we believe that using online focus groups is a feasible approach when conducting a study on low-income, racial/ethnic minority community college students. Declining participation could have also been related to other factors not associated with the research study.
The introduction of the use of a video conferencing platform presented data collection challenges that are not present during in-person data collection. The online video conferencing platform provides the option to have the video turned on. Although participants were not required to turn their videos on, it was highly encouraged, and most participants chose to do so. The video allowed the facilitator to capture nonverbals during the focus groups, and this created greater rapport between the facilitator and participants, similar to in-person focus groups. However, some individuals had difficulty muting their microphone when not speaking and noises in the background interfered with the discussion. Other participants had their video on, and it was visible that they were distracted (e.g., driving, at work, attending to children/doing chores around the house). This negatively impacted their engagement in the discussion, in addition to the concentration of the facilitator and participants on the call. Other individuals were muted and chose not to turn their video, and it was observed that individuals that had their video turned off were also less engaged in the focus group conversation. To minimize the distractions, the research team decided to aim for smaller size focus groups that included 3–4 participants, rather than the targeted 6–8 participants during the in-person focus group. The approach has also been done by other research teams (Dos Santos Marques et al., 2020). Although these challenges are not observed during in-person focus groups, the research team concluded that the use of a video conferencing platform is a valuable mode of data collection as it made the study accessible to participants that may have chosen not to engage in the study otherwise.
Feasibility of Accessing the Resources Needed to Recruit Participants During a Pandemic and Collect Data using a Video Conferencing Platform
This transition of conducting focus groups from in-person to online was facilitated by several resources that were already in place prior to the pandemic. First, the chosen video conferencing platform was already somewhat familiar to majority of the participants from other settings (school, work, or personal) and to the research team. As mentioned above, smartphones, tablets, and computers with data or internet connectivity was also accessible to the study participants. Although some technology troubleshooting was necessary, overall setting up the account associated with the virtual conferencing platform and logging in was not found to be difficult among the participants. Other research teams have found a similar ease among participants setting up their online video conferencing platforms (Dodds & Hess, 2020), while technology illiteracy did appear to be a significant barrier in others (Dos Santos Marques et al., 2020). Grant funds were available for the research team to upgrade the video conference package in order to meet the needs of the study.
Second, a research team familiar with the project was formed prior to the pandemic. With the in-person focus groups, 3–4 members from the research team were needed in preparing for each focus group such as scheduling the lab, parking vouchers, research assistant availability, recording devices, ordering and picking up lunch/snacks, and setting up data collection materials. However, with the online focus groups, many of these factors were no longer needed as participants were not attending the meeting in-person. Instead, during the online focus groups the preparation steps were reduced significantly. Preparation for the online focus group involved a research assistant being available to troubleshoot difficulties with participants logging into the online platform.
Conclusion
The COVID-19 pandemic required academic research to pivot and consequently revealed inequities. The transition required researchers to reconsider traditional methods of data collection. Although the research team was aware that study population would be hard-to-reach, an online video conferencing platform was not considered from the onset of the study as a way to make the study more accessible. On the contrary, online video conferencing was viewed as a barrier to participation due to the technology literacy required and potential data charging costs that is associated with using an online platform. Online video conferencing technology was only considered when no other alternative method to continue conducting the study was available. This study demonstrated the feasibility of conducing online focus groups and a viable alternative to in-person focus groups, similar to recent studies (Dodds & Hess, 2020; Dos Santos Marques et al., 2020) and recommendations (Marhefka et al., 2020; Santhosh et al., 2021). Although there are challenges with online focus groups, future studies are encouraged to consider offering online options, in addition to in-person options, as an approach to make research studies more accessible.
